Time to surgery in patients with colorectal liver metastases

BACKGROUND: Surgical resection and locoregional therapies are crucial for the curative treatment of colorectal liver metastases (CRLM). The impact of time to surgery on long-term survival is unclear. Evidence from other hepatobiliary cancers suggests surgical delays do not adversely affect outcomes. We aimed to investigate the impact of time between treatment referral and surgical intervention on overall survival in patients with CRLM. We also sought to identify clinical predictors of time to surgery.

METHODS: This nationwide study included patients with CRLM between March 2013 and December 2023 in Denmark. Multivariable Cox proportional hazards models examined the association between time to surgery and mortality risk. Kaplan-Meier estimators described long-term survival. Linear regression identified clinical predictors of the time between referral and surgery.

RESULTS: Among 2732 patients included, the median time to surgery was 28 days. Unadjusted analysis indicated a 3% increase in mortality per additional week from referral to surgery (hazard ratio (HR) 1.03, 95% CI 1.01-1.05). However, adjusted analyses did not confirm this association (HR 1.02, 95% CI 0.99-1.05). Five-year survival did not differ significantly between patients treated within 28 days and those after. More than one multidisciplinary team conference held before surgery were associated with longer time to surgery.

CONCLUSIONS: Time to surgery has little effect on survival and mortality risk in CRLM patients. Additional waiting time associated with multiple MDT conferences likely reflect necessary preoperative optimization. Further research is needed in populations without fast-track cancer pathways.